NEW YORK: My dad got sick a year ago with an illness that requires full-time care. My mother is basically in charge of his care, which I think she's handling well, all things considered. They live about a 15-hour drive away.

My mother and I have always had a very fraught relationship. She's a very lonely, needy person, and so if she, say, asks to come visit me and I say it's not a good time, I often get a long teary rant about how she never goes anywhere, etc. Before my dad got sick I was doing pretty well, I thought, with managing her manipulations. I realized that even if I did everything she asked, I wouldn't be able to fix what was making her so unhappy. I was working on setting my boundaries at a place that felt pretty comfortable and was getting better at saying no. I even thought she was learning that she couldn't control me forever.

But then my dad got sick, her demands ramped up, and now I feel really guilty all the time, like it would be cruel of me to tell her no when she asks (demands) that I do something that's tough for me. It doesn't help that my sister's in the same city as my family, so I'm basically the "unhelpful sibling" (my words, not theirs explicitly). Any thoughts about how to maintain boundaries with my mom in such changed circumstances?

CAROLYN: Please realize that while your dad's health has changed, very little about your relationship with your mom has changed.

You still won't be able to fix what is making her so unhappy, even if you do everything she wants.

It's still okay to say "no."

She still can't control you forever, unless you hand over the reins.

It's just one small tactic, but this might help alleviate the extra strain: Every time you have to say no to Mom, offer a "yes" — one that's on your terms — to something else. For example, "Sure, you can come visit — this isn't a good time, but the second or third weekend of October would work." That way you continue to enforce your boundaries while handing her less ammunition for needy outbursts. If you get into a situation where you don't have a "yes" at your fingertips, say, "Let me check a few things and get back to you." Then line up your yes and your no, and call back. It won't prevent all teary rants, but it will help you stand your ground through them, by giving you solid footing against guilt.

HOUSTON: Regarding New York:

Also start researching assistance where your parents live and their insurance coverage, including occasional or not-so-occasional at-home care as a way to ease your mother's burden. This can give her the chance to get out of the house and socialize.

Also look into the gift of a maid service or catering service to help your mom with everyday chores. You get to keep your boundaries and still help her. Win-win.

CAROLYN: Often, too, a specific illness will have an advocacy group dedicated to it, offering, among other things, support groups, provider referrals, legal and insurance advice, medical equipment, and in many cases respite care to give caregivers a break.